44Requires nonprofit community health clinics to spend 90% of revenue on health care services

#Key findings

• The pay problem is real. In 2024 the CEOs of AltaMed and North East Medical Services each made about $1.95M. Three other clinic CEOs made $667K to $730K. ^[1]
• None of the 7 clinics funding the No campaign meets 90%. Their combined ratio is 77.4% on $3.28B in revenue, and two are under 65%. Several ran 14–17% surpluses. ^[1]
• LAO: clinics report spending an average of about 80% of revenue on health care services, though it varies by clinic. ^[2]
• The sponsor is a union that tried the same rule as a bill (AB 1113), which died in committee (filed away Feb 2, 2026). ^[3][4] Clinics allege in federal court that it offered to drop Prop 44 for union membership. The union calls that "categorically false." ^[3]
• The same union is behind Prop 40 ^[3], and its dialysis measures failed three times (43%, 37%, 32% yes in 2018, 2020, 2022). ^[5]

#Track record

Clinics funding the No side (2024 filings)

#Money and conflicts

• Yes $16.9M, all from SEIU-UHW. No $38.6M, led by AltaMed ($6.1M) and the clinic association. ^[6][1]
• Both sides have a stake. The clinics are fighting a rule they'd fail. The union represents health workers and has sponsored initiatives aimed at health care employers before (the dialysis measures).
• The clinic association's claim that "nearly half of clinics could close" (with $1.7B in first-year penalties) comes from a study it paid for. ^[3]

#Does it solve a lasting problem?

• It targets a real issue (executive pay, surpluses, overhead) with a blunt rule. It's unclear exactly which costs would count as health care services; the Attorney General would define that. ^[2] A disclosure-and-audit approach could address pay without risking clinic cuts.

#If you vote yes: accountability

Bottom line: The Attorney General would define what counts as "health care services," and that definition decides which clinics pass. ^[2] The clinics fighting the measure combined spend 77.4% of revenue on care, so watch whether they cut overhead or care. ^[1]

#Who's accountable

• The Attorney General writes the definitions. That race (Bonta vs. Gates) is on this ballot.
• The state checks compliance using the financial reports clinics already file with the federal government, and collects fees from clinics to cover enforcement. The measure doesn't name a department. ^[2]
• Clinic boards. Most are private nonprofits, so they aren't covered by the Public Records Act, but their federal tax returns (Form 990s) are public.

#What to watch

• Waivers: the measure allows temporary waivers, but doesn't say who grants them or on what grounds. ^[2]
• Whether clinics close or cut services, as the clinic association predicts (in a study it paid for), or whether executive pay and surpluses shrink. ^[3]

#Who to press, and what to ask for

• Attorney General candidates: will the definitions of "health care services" be written in public, with draft rules and comment periods?
• Your local clinic's board: ask for its ratio of care spending to revenue, and its executive pay, both reported on its Form 990.

#Records to look up

Anyone can file a California Public Records Act request (the state's version of FOIA), with no reason required. Agencies must respond within 10 days, or 24 in unusual cases. ^[7] For private clinics, use public Form 990s instead, which you can search on ProPublica's Nonprofit Explorer. ^[8]

To the Attorney General's office (after passage): Under the California Public Records Act (Gov. Code § 7920.000 et seq.), I request all draft definitions, public comments, and communications with clinic operators or SEIU-UHW about defining health care services under Proposition 44.